Please keep in mind that while I am not a
Veterinarian, I do have extensive Nursing and Pharmacy training and knowledge.
This information is not meant to be a diagnosis at all, simply guidelines and
information. You should have your dogs tested and checked by a Canine
Cardiologist as this is the best way to detect any early indications of heart
disease and possibly treating your dog to buy him/her a little longer quality of
life. Denying this disease exists is not going to do the breed any favors at
all, therefore honesty is the best policy if we are ever going to find a DNA
marker to test for predisposition of this killer disease.
Question: If caught in the early stages,
can medication keep cardio in remission or will it automatically
progress, regardless of medication and diet ?
Answer: Studies have proven and indicated that no
matter what supplements or medications are given, even if caught in the early
stages, this disease WILL progress. One study showed that less than 5% of the
time improvement or regression occurred when the dog was given a nutritional
supplement called L-Carnitine. The dose for an
adult Doberman is 2 grams every 8 hours. If an arrhythmia is found, antiarrhythmic medications can be tried in order to
stave off sudden death.
Question: Is there any relationship of DCM to a low
protein diet and possible Taurine deficiency due to
that diet ?
Answer: Studies have shown there is no taurine deficiency with Dobermans diagnosed with DCM,
however, a serum or plasma taurine level is
certainly worth having done. Diagnostic labs have the ability to perform this
test. A few Dobermans have been found to have a Carnitine deficiency though. It may almost be simpler to supplement with L-Carnitine and Taurine – here is an awesome site to explain a
little more about L-Carnitine and Taurine: http://www.caninehearthealth.com/carnitine.htm .
Question: Is there any recommendations for specific
treatment of occult DCM with respect to slowing the progression of DCM?
Answer: there is nothing proven yet to stop or slow
the progression of early DCM. If ventricular arrhythmias are present,
anti-arrhythmic drugs and/or digoxin can be
started when the heart muscle becomes weak. ACE inhibitors are generally used
for significant heart chamber dilation. Heart healthy supplements such as tauine, L-Carnitine,
Coenzyme Q10, and Omega fatty acids have also been recommended in the early
stages but there is no proof that they do a lot of good except in the truly rare
deficient cases.
Question: Some centers have reported the incidence of
occult DCM is very high. Are there any prophylactic strategies for ALL dobermans?
Answer: the best way to screen for early detection of
DCM is with a 24 hour Holter monitor combined with a yearly ultrasound echocardiogram. This method of testing is HIGHLY
encouraged for active breeders who truly want to better the breed and stop or
avoid spreading this disease further. It can also be recommended for pets as
well due to the fact that there is no other early detection testing available.
While early detection may not help with the overall survival of the dog, it
certainly will make possible for the breeder to remove those dogs tested
positive for the disease to be removed from future breeding and for the pet
owner, the results may help prepare the owner for what lies ahead instead of
devastating surprise. Testing is the only way to decrease the incidence of this
disease.
Question: some dogs have been diagnosed with cardio
while others have just dropped dead while playing, etc… are there any signs that
we should be looking for to indicate this disease may be present in my dog ?
Answer: there are no early symptoms seen during the
occult phase of this disease which is why the only way to detect it is to test
for it.
Question: Can Holter monitoring truly catch the early warning signs of cardio?
Answer: Yes. Ventricular arrhythmias are considered
the earliest signs that DCM is present. Greater than 50 abnormal beats in a 24
hour period would be highly suspicious of developing DCM.
Question: Is there any known inheritance pattern of
cardio?
Answer: The mode of inheritance has not been
identified to my knowledge. Again, it is of utmost importance to do the
necessary testing available until a mode of inheritance is established.
Question: Does health and exercise play a role in
helping to decrease the odds of cardio similar to a heart attack or are the
genetics predetermined and eventually the heart will give out regardless?
Answer: No unfortunately. A super athlete can
develop the disease just as easily as the couch potato if he/she is predisposed
to the disease.
Question: can a dog be resuscitated after suffering
sudden death?
Answer: the best chance a dog has to be resuscitated
following sudden death is at a vet clinic that has access to a cardiac
defibrillator. If it happens at home, the chances are slim to none that you will
be able to revive the dog. You must first determine if the dog has simply
fainted, in which case he/she will likely revive him/herself, (check with a
mirror by the mouth or nose for breaths and/or listen with a stethoscope for
heart beats) but if the dog has arrested, you could try doing mouth to nose
resuscitation and chest compressions but please keep in mind you may not be
successful in bringing him/her back.
Question: if the dog is having erratic heartbeats or
arrhythmias, is there anything that can be done to control the arrhythmias and
if the dog tries to die, should I attempt to revive him/her?
Answer: Erratic heartbeats are most likely
arrhythmias. Beta blockers such as Atenolol is a
class of drug shown to decrease the incidence of sudden death, however dogs can
still die while taking these Beta blockers if their heart disease is bad enough.
Omega 3 fatty acids such as found in fish oils have some protection for sudden
death as well but that is not to say, they will prevent sudden death. Again, you
need to determine if the dog has fainted or in fact has arrested. You may try
mouth to nose resuscitation if the dog has arrested along with chest
compressions, but without a cardiac defibrillator, the chances of reviving the
dog are slim to none.
Question: we all know that Cardio is a broad term for
heart problems. Dogs that are 9 yrs and older that develop heart problems or die
suddenly, is it from DCM, an embolism, a stroke, or just an old dog heart?
Answer: Veterinarian Cardiologists don’t use the term
‘cardio’, rather they use specific diagnostic terms for the actual disease.
Sudden death in older dogs could be due to a broad number of different diseases,
cardiac-related or non-cardiac-related. Old dog hearts apparently don’t just
wear out from old age as there is an associated disease that causes problems
such as disease of the heart valves which causes them to leak or disease of the
heart muscles itself (DCM).
Question: I heard a breeder say that Dobermans 8 years
plus with Congestive Heart Failure do NOT have the type of Cardiomyopathy that is hereditary and that CHF is a ‘normal’ part of
aging. Can you explain the difference?
Answer: Congestive Heart Failure (CHF) is not a
normal part of aging. It is due to a true pathology or disease of the heart
where fluid accumulates in the lungs and/or in the abdomen or from side effects
of medications being used to treat the CHF. Dilated Cardiomyopathy causing sudden death is the same disease as DCM causing
congestive heart failure. There are two different outcomes. With sudden death,
the associated arrhythmias are the more lethal part of the disease and cause the
dog to drop dead suddenly. 25 – 30% of Dobermans die this way. The other 75%
may also have ventricular arrhythmias but they are less aggressive and don’t
cause death. Instead, these dogs eventually die from Congestive Heart Failure (CHF). Please check out my article on CHF to learn more
about it.
Question: Is a 24 hour Holter test the best indicator for determining an acute sudden death episode?
Answer: There are some dogs with lots of PVC’s that
don’t die suddenly. There seems to be a problem with correlation between what
is the optimal # of PVC’s for causing sudden death. One dog may have 600 PVC’s
in 24 hours and suffer sudden death whereas another dog that has 2000 PVC’s in
24 hours won’t die. Other indicators looked for on the Holter to attempt to predict a dog’s risk for sudden death are the number
of runs of rapid ventricular tachycardia (lots of PVC’s occurring one after the
other), and R-on-T phenomenon, when one PVC starts before the one before has
completely ended. Certainly a Holter is one of the
best ways for early detection, another being an echocardiogram.
Question: If dogs are dropping dead from ventricular
tachycardia, would it not be advantageous to place implantable cardioverter-defibrillators (ICDs)
in these dogs as soon as they start to show abnormal changes in EKGs?
Answer: Sudden death is usually caused by a prolonged
bout of ventricular tachycardia which degenerates into ventricular
fibrillation. The cost of implanting ICDs as well
as the cost of the ICDs themselves is likely the
major factor limiting this procedure. Another problem is that the Doberman with
DCM, the arrhythmias don’t always cause sudden death but rather the disease will
progress shortly afterwards to CHF which will then likely kill the dog.
Question: What does it mean if a breeder advertises a
dog as ‘Cardio Clear’ and does that mean that the dog will be clear for life?
Answer: ‘Cardio Clear’ simply means that the dog
tested ‘clear’ at the time of the test and no, it does not mean the dog
will be clear for life. You must remember that the testing available at the
moment is just that – a test for that day, for that moment! Until such time as
a definitive DNA test becomes available to determine which dogs are predisposed
to the disease, nothing is definitive and certainly not for life. The best way
to test is Holter your dogs AND have an
echocardiogram done at least once yearly to compare to the base test (the first
one) to watch for any indications of changes occurring which may lead to DCM
later on.
Question: If the SF in an echocardiogram is 30+ and a Holter shows 100 PVCs/hour,
should the dog be put on meds for acute sudden death?
Answer: Yes, even though the echo shows normal heart
function, the large number of PVCs put the dog at
risk for sudden death. This is a perfect example of why both tests should be
done because with doing just and echo, one might believe that the dog is in fact
‘clear’ where the Holter picks up the PVCs indicating a problems exists or is starting.
What makes this disease so devastating is that
without doing these tests, and given the hallmarks that this disease has a long
2-3 year occult phase during which the dog shows no outward symptoms through
appearance or activity level, oftentimes the first indication of a problem
brewing is they go into CHF or die suddenly from undetected arrhythmias. Just
having a vet listen to the heart with a stethoscope or have a 3 minutes ECG
strip done will not always pick up a murmur, arrhythmia and the ONLY way is to Holter and/or echo the dog regularly. |
